| NPI | 1528563426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: RI MD20473) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 1023205) | |
| Enumeration Date | 2018-03-24 |
| Last Update Date | 2025-03-21 |